Teens and Young Adults: Achievement With Hearing Loss

November 2012

Carrie Spangler, AuD, CCC-A

In order to achieve in our public schools, students with hearing loss need support, including information about their hearing loss, advocacy skills, communication barriers/solutions, and technology and services available to them after graduation. Educational audiologists may be one of the main related service providers and, as such, have a commitment to guide professionals, parents, and students/clients to appropriately access the Common Core State Standards (CCSS) and Transition Postsecondary goals. The CCSS Initiative, which has been adopted by 45 states, is a state-led effort coordinated by the National Governors Association Center for Best Practices (NGA Center) and the Council of Chief State School Officers (CCSSO). These standards define the knowledge and skills students should acquire during their K–12 education so that, following graduation, they will be able to succeed in entry-level, credit-bearing academic college courses and in workforce training programs (National Governors Association Center for Best Practices, 2010). The IDEA 2004 Secondary Transition Goals are designed to help students with disabilities transition to life after high school.

IDEA 2004 and Postsecondary Transition

IDEA 2004 defines secondary transition as "designed to be within a results oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child's movement from school to post-school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation." Transition refers to a change in status from behaving primarily as a student to assuming emergent adult roles in the community. These roles relate to employment, postsecondary education, home maintenance, and appropriate involvement in the community (Halpern, 1994).

Stitlington et al. (Stitlington, Neubert, Gegun, Lombard, & Leconte, 2007) recommended acquiring transition assessment information regarding a student's current needs, preferences, and interests as they relate to the demands of current and future working, educational, living, personal, and social environments. The goal of transition assessment is to assist students, families, and professionals as they make transition planning decisions for student success in postsecondary environments.

Postsecondary goals are "generally understood to refer to those goals that a child hopes to achieve after leaving secondary school (i.e., high school)," according to IDEA 2004 Part B Regulations: §300.320 (b) (discussion of Final Rule p. 46,668). However, the high school graduate may no longer be eligible for public school services that facilitate education, employment, and independent living. Hearing loss and communication accommodations need to be important considerations for continued success in these three transition areas.

Common Core Anchor Standards

In addition to the postsecondary goals, schools across the nation are implementing the Common Core State Standards (CCSS). The CCSS for English Language Arts includes skills in reading, writing, speaking, listening, and language. Within the CCSS are the Standards for College and Career Readiness (CCR) Anchor Standards for Speaking and Listening, which comprise skills and understandings that all students are expected to have acquired by the time they graduate from high school.

The CCR Anchor Standards for Speaking and Listening states "To become college and career ready, students must have ample opportunities to take part in a variety of rich, structured conversations. Whatever the intended major or profession, high school graduates will depend heavily on their ability to listen attentively to others [emphasis added] so that they are able to build on others' meritorious ideas while expressing their own clearly and persuasively " [emphasis added] (National Governors Association Center for Best Practices, 2010).

CCR Anchor Standards for Speaking and Listening Grades 11–12 Students

Comprehension and Collaboration

Initiate and participate effectively in a range of collaborative discussions (one-on-one, in groups, and teacher-led) with diverse partners on grades 11–12 topics, texts, and issues, building on others' ideas and expressing their own clearly and persuasively.

Come to discussions prepared, having read and researched material under study; explicitly draw on that preparation by referring to evidence from texts and other research on the topic or issue to stimulate a thoughtful, well-reasoned exchange of ideas.

Work with peers to promote civil, democratic discussions and decision-making, set clear goals and deadlines, and establish individual roles as needed.

Propel conversations by posing and responding to questions that probe reasoning and evidence; ensure a hearing for a full range of positions on a topic or issue; clarify, verify, or challenge ideas and conclusions; and promote divergent and creative perspectives.

Respond thoughtfully to diverse perspectives; synthesize comments, claims, and evidence made on all sides of an issue; resolve contradictions when possible; and determine what additional information or research is required to deepen the investigation or complete the task.

Integrate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, orally) in order to make informed decisions and solve problems, evaluating the credibility and accuracy of each source and noting any discrepancies among the data.

Evaluate a speaker's point of view, reasoning, and use of evidence and rhetoric, assessing the stance, premises, links among ideas, word choice, points of emphasis, and tone used.

Presentation of Knowledge and Ideas

Present information, findings, and supporting evidence, conveying a clear and distinct perspective, such that listeners can follow the line of reasoning, alternative or opposing perspectives are addressed, and the organization, development, substance, and style are appropriate to purpose, audience, and a range of formal and informal tasks.

Make strategic use of digital media (e.g., textual, graphical, audio, visual, and interactive elements) in presentations to enhance understanding of findings, reasoning, and evidence and to add interest.

Adapt speech to a variety of contexts and tasks, demonstrating a command of formal English when indicated or appropriate. (See grades 11–12 Language standards 1 and 3 on page 54 for specific expectations.)

From Common Core State Standards for English Language Arts & Literacy in Historical/Social Studies, Science, and Technical Subjects (p. 50), by the National Governors Association Center for Best Practices, Council of Chief State School Officers, 2010, Washington, DC: National Governors Association Center for Best Practices, Council of Chief State School Officers. Copyright 2010 by the National Governors Association Center for Best Practices and Council of Chief State School Officers. All rights reserved.

Prioritizing the Role of Educational Audiology in Transition Planning and CCR Anchor Standards

"It is also beyond the scope of the CCSS to define the full range of supports appropriate for English language learners and for students with special needs. At the same time, all students must have the opportunity to learn and meet the same high standards if they are to access the knowledge and skills necessary in their post-high school lives" (National Governors Association Center for Best Practices, 2010).

In the schools, the educational audiologist may be the appropriate related service provider on the IEP transition team to provide input and direction regarding the needs of students with hearing loss as they transition from school age to graduation. The audiologist's knowledge and skills in the area of aural rehabilitation (AR)—along with the rigorous expectations in the CCR for Speaking and Listening—and the list of services defined in Secondary Transition are evidence of the critical role educational audiologists play in this important process for students who have hearing loss. AR services provided by educational audiologists include management of technology and devices in the child's natural (classroom) environment, speechreading, auditory training, communication strategies, use and care of hearing aids, collaborative approach to serving children with cochlear implants, and hearing assistive technology systems (HATS), self-management of hearing needs, and other areas as appropriate (American Speech-Language-Hearing Association, 2004).

Considering the high expectations of the CCR Anchor Standards for Speaking and Listening, professionals working with students with hearing loss can predict that these students will be at a distinct disadvantage, unless they have received appropriate interventions, technology, accommodations, and strategies from an early age.

How can we, as professionals, encourage and support teens with hearing loss as they transition to the real world and meet the CCR Anchor Standards? We can help the student

understand his or her hearing loss and the communication barriers that may present challenges in a variety of listening and speaking situations;

fully understand how available technology-including hearing aids, cochlear implants, and hearing assistive technology-can open the door for connecting;

Resources and Tools to Get Started

GAP (Guide to Access Planning)

One tool that can be helpful in meeting postsecondary transition goals and incorporating CCR Standards is the Guide to Access Planning (GAP). This free tool is available on the Phonak website and is designed to help audiologists, speech-language pathologists, and teachers of the deaf develop transition activities for students with hearing loss (Phonak, 2012).

Purpose and Goal of the GAP Program

The purpose of the GAP program is to provide information that is important for the student with hearing loss to effectively advocate and be responsible for his/her communication access supports and, in particular, hearing assistance technologies. For a student who is currently in middle or high school, the information is intended to be integrated into his or her IEP, IEP Transition Plan, and/or Summary of Performance. These are required documents to prepare students for life after high school.

One way to develop, organize, and track a student's skills and transition needs is to begin a GAP notebook. This can be done electronically or by using a three-ring binder. Topics of individual sections may include assessments, hearing aid/cochlear implant technology, hearing assistance technology, advocacy and the law, college resources, employment resources, and independent living. The GAP provides resources in all of these areas. The educational audiologist, student, and team can personalize the notebook to reflect each student's individualized needs.

Getting Started With GAP: Finding Out What the Student Knows

The Transition Checklist and the Self-Assessment and Self-Advocacy Checklists are three documents that can be used to help meet the intent of the Federal law requiring "appropriate, measurable post-school goals [be] based upon age-appropriate transition assessments [emphasis added], related to training, education, employment, and where appropriate independent living skills," per IDEA 2004 34 CFR 300.320(b) and (c) and 20 U.S.C. 1414 (d)(1)(A)(i)(VIII). The "Planners" provided with each of these checklists include goals to be addressed in each of these areas as well as who is responsible and the timeline.

The GAP Transition Checklist includes 12 important skill areas that lead to self-advocacy and personal responsibility and the Self-Assessment specifically addresses areas associated with hearing, communication, and hearing assistance technology. The results of these assessments become the basis for your GAP Transition Planner or your GAP Self-Assessment Planner.

The educational audiologist can use this checklist/assessment tool to identify the areas of deficit in the CCR as well as the areas of the Postsecondary Transition plan (education/work/independent living) that need attention. This gives the educational audiologist and the entire IEP team a framework on which to develop goals and activities.

Listening Inventory for Education-Revised (LIFE-R)

Another tool that can help educational audiologists find out more about student skill levels in the areas of advocacy and classroom participation is the LIFE-R. This tool also ties into the Post-Secondary Goals and Assessment of the Transition Plan for the IEP as well as the CCR for Speaking and Listening. The LIFE-R gives the educational audiologist a way to obtain information from the student and teacher regarding classroom and social listening difficulties. The deficit areas that arise from completion of the LIFE-R tie directly into the CCR Anchor Standards for Speaking and Listening. It gives the educational audiologist a framework to start from to help the student overcome difficulties experienced in the classroom so that he or she can contribute appropriately. These might include such strategies as

Technology and Apps

Today, we live in a world where people stay connected electronically though cell phones, Bluetooth devices, tablets, and many other devices. The everyday use of these technologies by the teenagers means that, as audiologists, we need to know how to "connect" students with hearing loss so that they can be successful socially and educationally in their classrooms and local communities, including the opportunity to meet the CCR Anchor Standards for Speaking and Listening.

Educational audiologists are uniquely qualified to help students with hearing loss achieve their goals as they begin to explore independent living, postsecondary education, and work. We can tap our expertise in hearing technology, as well as creative thinking and problem solving skills, to help students with hearing loss connect to the hearing world and modify situations as needed.

Consider the following scenarios.

Independent Living: The student is interested in apartment living. The educational audiologist can direct the student to explore apartment living and safety as it relates to hearing and listening-specifically including safety technology such as fire alarms and other alerting devices. It can also include creative thinking for use of apps such as "Subtitles," which enables access to captions for films. Connecting a streaming device to the TV may enhance acoustic access to programs. The educational audiologist might want to explore how the student can "register" his or her phone number with emergency services (i.e., to alert the dispatcher that the individual may have difficulty understanding on the phone).

Work: The student's goal is to work and earn an income. The educational audiologist can guide the student in investigating possible career paths and exploring the listening and communication situations that may be faced. This may include exploring acoustical and communication demands and creatively helping the student to problem solve. Examples may include ways to effectively loop a workplace or connect wirelessly to a GPS (e.g., for a delivery job) and apps that aid in organization and timeliness or offer speech-to-text communication to aid in situations when the student cannot understand what others say.

Postsecondary Education: The student's goal is to attend college. The educational audiologist may arrange campus visits to explore accessibility. The student and audiologist can explore the use of personal FM system for classroom lectures as well as small-group interactions. The student may need to use programs such as Amara (crowd source captioning) to provide captioning for YouTube videos that do not have captioning.

Improvements in technology are leading to better communication and access for individuals with hearing loss. Tina Childress, educational audiologist and bilateral cochlear implant user, has put together a list of apps and resources that can be accessed at Apps for Kids with Hearing Loss (Childress, 2011). Depending on the deficit areas of the student you are working with; a number of these apps may be worth exploring. By assessing the student's areas of difficulty and exploring low-cost and free apps, the educational audiologist can find creative ways to help students open up technology and communication options.

Integrating CCR Anchor Standards and the Transition Plan

Profile: A high school sophomore who has a hearing loss and wears hearing aids wants to apply for a job at a local store. This student is unaware of times when he is missing important elements in group discussions at school. He is also hesitant at times to notify others that he has a hearing loss. He would like to also go to college one day, but has been hesitant about using assistive technology.

Relevant CCR Standards and Transition Activities

CCR Anchor Standard in Speaking and Listening: Prepare for and participate effectively in a range of conversations and collaborations with diverse partners, building on others' ideas and expressing their own clearly and persuasively.

Transition Postsecondary Goals: Attend a 4-year college while working at a local merchant to pay for rent.

Transition Postsecondary Activity: Explore the work and postsecondary education options paying specific attention to how the hearing loss may impact the student and, as a team, collaborate to explore accommodations, technology, and resources to help the student meet postsecondary goals.

Transition Activities to Addressing the Goals

The GAP has materials located in the information, hearing loss, technology, and activity sections that can assist the student to learn more about the deficient areas identified in the learning plan. In addition to the materials, there are other documents in this program that are personalized. These include the Personal Profile and Accommodations Letter, located in the Self-Advocacy section, to use in the student's school, college, job training, and/or employment settings to advocate for good communication.

The educational audiologist can participate and lead an IEP meeting and present a plan for post-school life to team members. These would include the possible modifications in listening and speaking that may need to be considered due to the student's hearing loss.

Completing the Student LIFE-R and the Teacher LIFE-R will give valuable feedback about the advocacy skills that are being displayed in the school setting. Deficit areas can be addressed through discussion, role play, and other activities that involve problem solving, such as a mind map activity.

The student and educational audiologist can explore options for effectively communicating on the phone with a future employer. This may include practice with a Bluetooth streaming device paired with a cell phone to figure out how much of the conversation is understood. Explore apps, such as Google Voice, that may assist in "filling in the gaps" of auditory information that may have been missed. They can also explore relay services for cell phone that are easy to use.

Summary

All students must have the opportunity to learn and meet the same high standards if they are to access the knowledge and skills necessary in their post-high school lives.

As educational audiologists, we can help students identify their barriers positively; take the knowledge and problem solve; and incorporate it effectively into the person they desire to be. Students who are transitioning out of high school into our community need to be equipped with the tools of advocacy, technology, and collaborative support in order to obtain the accommodations needed to be successful.

About the Author

Carrie Spangler, AuD, has been employed at Stark County Educational Service Center in Ohio since 1999. Dr. Spangler graduated from the University of Akron with a master's degree in audiology and Arizona School of Health Sciences with a doctorate in audiology. She specializes in educational and pediatric audiology and is one of the developers of the GAP (Guide to Access Planning) program and the LIFE-R. She is the 2012 recipient of the Cheryl DeConde-Johnson Award for outstanding achievement in Educational and Pediatric Audiology. Dr. Spangler brings a personal perspective to the profession, having been born with a severe to profound hearing loss and worn hearing aids from a young age. At Stark County, she organizes a teen group of students who are deaf and hard of hearing to develop self-advocacy and personal responsibility skills regarding their hearing loss. As a consumer, she experiences communication access issues on a daily basis and lends authenticity to the profession by incorporating these personal experiences. Contact her at carrie.spangler@email.sparcc.org.

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